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Effectiveness in Disease and Injury Prevention Child Passenger Restraint Use and Motor-Vehicle-Related Fatalities Among Children -- United States, 1982 - 1990

Although in recent years the increase in child safety seat use in the United States has saved lives of and prevented injuries to infants (children aged less than or equal to 1 year) and toddlers (children aged 1-4 years), the leading cause of death among U.S. children aged 1-4 years continues to be injuries to motor-vehicle occupants (1). These injuries account for the largest number of years of potential life lost before age 65 and the highest costs associated with pediatric injury (2). This report, based on data from the Fatal Accident Reporting System (FARS) (maintained by the National Highway Traffic Safety Administration), summarizes overall trends from 1982 through 1990 for motor-vehicle-related fatalities among children and lives saved by child passenger restraint use.

In the United States, in 1990, child safety seats were used for an estimated 83% of infants and 84% of toddlers, compared with 60% and 38%, respectively, in 1983 (Table 1) (3). Despite this level of use, 500-700 infants and toddlers died each year from 1983 through 1990 in traffic crashes (4). In 1990, FARS reported that 624 children less than 5 years of age were killed in motor-vehicle crashes, of whom 70% were not restrained. Compared with children in the general population, fatally injured children and survivors of fatal crashes (i.e., crashes in which at least one fatality occurred within 30 days of the crash) were substantially less likely to have been restrained by child safety seats (Table 1).

Use of child safety seats reduced the likelihood of fatal injury by an estimated 69% for infants and 47% for toddlers. Adult safety belts used for toddlers reduced the likelihood of fatal injury by 36% (5-7). Based on these estimates, from 1982 through 1990, the use of restraints (both child safety seats and adult safety belts) saved an estimated total of 1546 lives of young children in passenger-vehicle crashes. Reported by: TM Klein, MC Walz, National Center for Statistics and Analysis, Research and Development, National Highway Traffic Safety Administration, US Dept of Transportation. Unintentional Injuries Section, Epidemiology Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: From 1985 through 1989, the number of fatalities among passenger-vehicle occupants less than 5 years of age increased steadily. Most of the increase appeared to be related to increased on-the-road exposure of children rather than to decreased child restraint use, increased improper use, or child restraint deficiencies (4). In addition, young children involved in fatal crashes may not be representative of the general population: children who are not restrained may be at greater risk for involvement in a potentially fatal crash (5)--a problem also characteristic of the high-risk adult population (8).

In 1978, Tennessee became the first state to implement a law requiring restraint of children in motor vehicles. By 1985, all 50 states and the District of Columbia had such mandatory-use laws in effect (9). These laws vary by state, some requiring use only until the child's first birthday, others until age 5 years. Although most states require that children be protected by child safety seats until the third or fourth birthday, some exceptions are permitted (e.g., travel in vehicles other than a parent's). The average fine for persons who fail to use safety restraints for children is approximately $40 (range: $10-$500); however, this fine is usually waived on proof of safety seat acquisition. A recent assessment of child restraint laws indicates their immediate benefit is to reduce fatalities by 9% (10). Because laws contribute to an increased use of restraints for young children and an increased awareness of restraint use in general, the potential benefits (e.g., reduction in fatalities and injuries in motor-vehicle crashes) may increase over time.

Further reductions in child crash fatalities will require education and motivation of parents to use child safety seats and safety belts. In addition, high-risk groups (i.e., those most likely to be involved in crashes) must be identified and targeted for intervention to increase the use of child safety seats.

References

  1. NCHS. Health--United States, 1990. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991.

  2. CDC. Childhood injuries in the United States. Am J Dis Child 1990;144:627-46.

  3. National Highway Traffic Safety Administration. Occupant protection trends in 19 cities. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1991.

  4. Klein TM, Van Dyke J, Surti J, Walz M. An investigation of the increase in child passenger fatalities since 1984. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1990; report no. DOT-HS-807-679.

  5. Partyka SC. Lives saved by child restraints from 1982 through 1987. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1988; report no. DOT-HS-807-371.

  6. Partyka SC. Papers on child restraints: effectiveness and use. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1988; report no. DOT-HS-807-286.

  7. Kahane CJ. An evaluation of child passenger safety: the effectiveness and benefits of safety seats. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1986; report no. DOT-HS-806-890.

  8. Chorba TL. Assessing technologies for preventing injuries in motor-vehicle crashes. Journal of Technology Assessment in Health Care 1991;7:294-312.

  9. National Highway Traffic Safety Administration. Buckle up for love. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1990; report no. DOT-HS-807-650.

  10. Partyka SC. Effect of child occupant protection laws on fatalities. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1989; report no. DOT-HS-807-453.



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